WOMEN'S QUESTIONNAIRE
PLACE NAME ____
REGION ____
EA NUMBER ____
STRUCTURE NUMBER ____
HOUSEHOLD NUMBER _____
WOMEN'S QUESTIONNAIRE 2
NAME AND LINE NUMBER OF WOMAN _____
MEDIUM CITY 2
SMALL CITY 3
TOWN 4
VILLAGE 5
INTERVIEW 1
DATE ___
INTERVIEWER'S NAME ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
NEXT VISIT:
DATE ___
TIME ___
INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
NEXT VISIT:
DATE ___
TIME ___
INTERVIEW 3
DATE ___
INTERVIEWER'S NAME ___
RESULT___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
FINAL VISIT
DAY___
MONTH ___
YEAR _19__
NAME ___
RESULT ___
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
NOT AT HOME 2
POSTPONED 3
REFUSED 4
PARTLY COMPLETED 5
OTHER (SPECIFY) ____ 6
LANGUAGE OF QUESTIONNAIRE: ENGLISH 1
NATIVE LANGUAGE OF RESPONDENT**___
AKAN 2
GA 3
EWE 4
HAUSA 5
DAGBANI 6
OTHER (SPECIFY) ____ 7
AKAN 2
GA 3
EWE 4
HAUSA 5
DAGBANI 6
OTHER (SPECIFY) ____ 7
NO 2
AKAN 2
GA 3
EWE 4
HAUSA 5
DAGBANI 6
OTHER (SPECIFY) ____ 7
SUPERVISOR
NAME ____
DATE ____
FIELD EDITOR
NAME ___
DATE ___
OFFICE EDITOR
______
KEYED BY
_______
SECTION 1. RESPONDENT'S BACKGROUND
MINUTES ___
101. COLLECT ANY RELEVANT DOCUMENTS THAT MAY HAVE INFORMATION ON THE RESPONDENT'S AGE AND HER CHILDREN'S AGE AND IMMUNIZATION.
102. First I would like to ask some questions about you and your household. For most of the time until you were 12 years old, did you live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
103. How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR ENTER '00'.
ALWAYS (SINCE BIRTH) 95 (GO TO 105)
VISITOR 96 (GO TO 105)
104. Just before you moved here, did you live in a city, in a town, or in a village?
TOWN 2
VILLAGE 3
105. In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 98
106. How old were you at your last birthday?
107. Have you ever attended school?
NO 2 (GO TO 111)
108. What is the highest level of school you attended: primary, middle/jss, secondary/sss, or higher?
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4
109. What is the highest grade you completed at that level?
SECONDARY/SSS AND HIGHER ___ (GO TO 112)
111. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?
WITH DIFFICULTY 2
NOT AT ALL 3 (GO TO 113)
112. Do you usually read a newspaper or magazine at least once a week?
NO 2
113. Do you usually listen to a radio every day?
NO 2
114. Do you usually watch television at least once a week?
NO 2
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
SPIRITUALIST 05
OTHER CHRISTIAN 06
MOSLEM 07
TRADITIONAL 08
NO RELIGION 09
OTHER (SPECIFY) ___ 96
116. To which ethnic group do you belong?
AKWAPIM 02
FANTE 03
OTHER AKAN 04
GA/ADANGBE 05
EWE 06
GUAN 07
MOLE-DAGBANI 08
GRUSSI 09
GRUMA 10
HAUSA 11
OTHER (SPECIFY) ____ 96
Now I would like to talk to you about all the pregnancies that you have had in your lifetime. By this I mean all the children born to you, whether they were born alive or dead, whether still living or not, whether living with you or elsewhere, and all the pregnancies that you have had that did not result in a live birth.
I understand that is not easy to talk about children who have died, or pregnancies that have terminated before full term, but it is extremely important that you tell us about all of them, so that we can develop programs that would help the Government of Ghana improve children's health in the future.
201. Now I would like to ask about all the births you have had during your life. Have you ever given birth?
NO 2 (GO TO 206)
202. Do you have any sons or daughters to whom you have given birth who are living with you?
NO 2 (GO TO 204)
203. How many sons live with you? And how many daughters live with you?
IF NONE, RECORD '00'.
DAUGHTERS AT HOME ____
204. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you?
NO 2 (GO TO 206)
205. How many sons are alive but do not live with you? And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
DAUGHTERS ELSEWHERE ___
206. Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but survived only a few hours or days?
NO 2 (GO TO 208)
207. In all, how many boys have died? And how many girls have died?
IF NONE RECORD '00'.
GIRLS DEAD __
208. Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end early, in a miscarriage, or the child can be born dead. Have you had any such pregnancy that did not result in a live birth?
NO 2 (GO TO 210)
209. In all, how many such pregnancies have there been?
210. SUM ANSWERS TO 203, 205, 207 AND 209 AND ENTER TOTAL.
IF NONE, RECORD '00'.
211. CHECK 210:
Just to make sure that I have this right: you have had in TOTAL ____ pregnancies during your life. Is that correct?
NO __ (PROBE AND CORRECT 201-210 AS NECESSARY)
NO PREGNANCIES (GO TO 234)
213. Now I would like to ask you about all of your pregnancies, whether born alive, born dead, or lost pregnancy, starting with the first one you had.
RECORD ALL THE PREGNANCIES. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. IF THERE ARE MORE THAN 11 PREGNANCIES, USE ADDITIONAL QUESTIONNAIRES.
214. Think back to the time of your (first/next) pregnancy.
215. Was that a single or multiple pregnancy?
MULTIPLE 2
216. Was the baby born alive, born dead, or did you lose this pregnancy?
BORN DEAD 2
LOST PREGNANCY 3 (GO TO 225)
217. Did that baby cry, move or breathe when it was born?
NO 2 (GO TO 225)
218. What was the name given to that child?
219. Is (NAME) a boy or a girl?
GIRL 2
220. In what month and year was (NAME) born?
PROBE: What is his/her birthday?
OR: In what season/significant event was he/she born?
YEAR ____
NO 2 (GO TO 224)
IF BORN ALIVE AND STILL LIVING:
222. How old was (NAME) at his/her last birthday?
RECORD AGE IN COMPLETED YEARS.
223. Is (NAME) living with you?
NO 2 (GO TO NEXT PREGNANCY)
224. IF BORN ALIVE BUT NOW DEAD: How old was (NAME) when he/she died?
IF '1 YR', PROBE: How many months old was (NAME)?
RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN TWO YEARS; OR YEARS.
MONTHS 2 ___
YEARS 3 ___ (GO TO NEXT PREGNANCY)
IF BORN DEAD OR LOST PREGNANCY:
225. In what month and year did this pregnancy end?
YEAR _____
226. How many months did the pregnancy last?
RECORD IN COMPLETED MONTHS.
227. FROM YEAR OF THIS PREGNANCY SUBTRACT YEAR OF PREVIOUS PREGNANCY. IS THE DIFFERENCE 3 OR MORE YEARS?
NO 2 (NEXT PREGNANCY)
228. Were there any other pregnancies between the previous pregnancy mentioned and this pregnancy?
NO 2
230. FROM YEAR OF INTERVIEW SUBTRACT YEAR OF LAST PREGNANCY.
IS THE DIFFERENCE 3 YEARS OR MORE?
NO 2 (GO TO 232)
231. Have you had any pregnancies since the last pregnancy mentioned?
IF YES, PROBE AND CORRECT Q. 214 TO Q. 228 IF NECESSARY.
NO 2
232. COMPARE 210 WITH NUMBER OF PREGNANCIES IN HISTORY ABOVE AND MARK:
CHECK:
FOR EACH PREGNANCY: YEAR IS RECORDED IN 220 OR 225. __
FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED IN 222. __
FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN 224. __
FOR EACH PREGNANCY LOSS: DURATION IS RECORDED IN 226. __
FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBE TO DETERMINE EXACT NUMBER OF MONTHS. __
233. CHECK 220 AND 225 AND ENTER THE NUMBER OF PREGNANCIES SINCE JANUARY 1993. IF NONE, RECORD '0'.
233A. CHECK 220 AND 221 AND ENTER THE NUMBER OF LIVING CHILDREN SINCE JANUARY 1993. IF NONE, RECORD '0'.
233B. CHECK 216 AND 217 AND ENTER THE NUMBER OF CHILDREN BORN ALIVE SINCE JANUARY 1993. IF NONE, RECORD '0'.
NO 2 (GO TO 237)
UNSURE 8 (GO TO 237)
235. How many months pregnant are you?
RECORD NUMBER OF COMPLETED MONTHS.
236. At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to become pregnant at all?
LATER 2
NOT AT ALL 3
237. When did you last menstrual period start?
WEEKS AGO 2 __
MONTHS AGO 3 ____
YEARS AGO 4 ___
IN MENOPAUSE 994
BEFORE LAST PREGNANCY 995
NEVER MENSTRUATED 996
301. Now I would like to talk about the various ways or methods that a couple can use to delay or avoid pregnancy. Which ways or methods have you heard about?
CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY.
THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY.
CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED.
THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302 AND 303.
301. Which ways or methods have you heard about?
READ DESCRIPTION OF EATH METHOD.
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
2 (SPECIFY) _____
302. Have you and your husband/partner ever used (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
YES 1
NO 2
YES 1
NO 2
303. Do you know where a person could go to get (method)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
AT LEAST ONE "YES" (EVER USED) (GO TO 307)
305. Have you ever used anything or tried in any way to delay or avoid getting pregnant?
NO 2 (GO TO 329B)
306. What have you used or done?
CORRECT 302-303 (AND 301 IF NECESSARY).
307. Now I would like to ask you about the time when you first did something or used a method to avoid getting pregnant.
How many living children did you have at that time, if any?
IF NONE, RECORD '00'.
308. When you first used family planning, did you want to have another child but at a later time, or did you not want to have another child at all?
DID NOT WANT ANOTHER CHILD 2
OTHER (SPECIFY) ____ 6
WOMAN STERILIZED __ (GO TO 314A)
PREGNANT __ (GO TO 329)
313. Are you or your husband/partner currently doing something or using any method to delay or avoid getting pregnant?
NO 2 (GO TO 329)
314. Which method are you using?
314A. CIRCLE '07' FOR FEMALE STERILIZATION.
IUD 02 (GO TO 324)
INJECTIONS 03 (GO TO 324)
NORPLANT 04 (GO TO 324)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 324)
CONDOM 06 (GO TO 324)
FEMALE STERILIZATION 07 (GO TO 318)
MALE STERILIZATION 08 (GO TO 318)
PERIODIC ABSTINENCE 09 (GO TO 323)
WITHDRAWAL 10 (GO TO 324)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 324)
OTHER (SPECIFY) ____ 96 (GO TO 324)
315A. At the time you first started using the pill, did you consult a doctor, nurse, midwife, or a pharmacist?
NO 2
315B. At the time you last got the pills, did you consult a doctor, nurse, midwife, or pharmacist?
NO 2
315C. May I see the package of pills you are using now?
RECORD NAME OF BRAND.
BRAND NAME ___ (GO TO 317)
PACKAGE NOT SEEN 2
316. Do you know the brand name of the pills you are using now?
RECORD NAME OF BRAND.
DON'T KNOW 98
317. How much did you pay for the pills the last time you go them?
FREE 9996
DON'T KNOW 9998
317A. How many cycles of pills did you get the last time?
DON'T KNOW 8
317B. Have you experienced any side effects from the use of the pill?
NO 2 (GO TO 324)
317C. What side effects have you experienced?
CIRCLE ALL MENTIONED.
WEIGHT GAIN B (GO TO 324)
HEADACHES C (GO TO 324)
EXCESSIVE BLEEDING D (GO TO 324)
IRREGULAR CYCLE E (GO TO 324)
PAINFUL PERIOD/CRAMPS F (GO TO 324)
PALPITATION/IRRECULAR HEART BEAT G (GO TO 324)
OTHER (SPECIFY) ___ (GO TO 324)
318. Where did the sterilization take place?
IF SOURCE IS HOSPITAL, HELATH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GVT. HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
OTHER PUBLIC (SPECIFY) ____ 16
MOBILE CLINIC 25
FP/PPAG CLINIC 27
MATERNITY HOME 28
OTHER PRIVATE (SPECIFY) ____ 29
DON'T KNOW 98
319. Do you regret that (you/your husband/partner) had the operation not to have any (more) children?
NO 2 (GO TO 321)
320. Why do you regret the operation?
SPOUSE WANTS ANOTHER CHILD 02
SIDE EFFECTS 03
CHILD DIED 04
OTHER (SPECIFY) ____ 96
321. In what month and year was the sterilization performed?
IF DON'T KNOW YEAR PROBE: How many years ago?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
321A. How old were you at the time of sterilization?
323. How do you determine which days of your monthly cycle not to have sexual relations?
BASED ON BODY TEMPERATURE 02
BASED ON CERVICAL MUCUS (BILLINGS METHOD) 03
BASED ON BODY TEMPERATURE AND CERVICAL MUCUS 04
NO SPECIFIC SYSTEM 05
OTHER (SPECIFY) ____ 96
324. For how many months have you been using (METHOD) continuously?
IF LESS THAN 1 MONTH, RECORD '00'.
8 YEARS OR LONGER 96
325. CHECK 314.
CIRCLE METHOD CODE:
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07 (GO TO 327A)
MALE STERILIZATION 08 (GO TO 327A)
PERIODIC ABSTINENCE 09 (GO TO 330)
WITHDRAWAL 10 (GO TO 330)
LACTATIONAL AMENORRHEA METHOD 11 (GO TO 326A)
OTHER (SPECIFY) ____ 96 (GO TO 330)
326. Where did you obtain (METHOD) the last time?
326A. Where did you learn how to use the Lactational Amenorrhea Method?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GVT. HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14 (GO TO 327)
FIELD WORKER 15 (GO TO 327)
OTHER PUBLIC (SPECIFY) ____ 16 (GO TO 327)
PHARMACY 22
CHEMIST 23
DRUG STORE 24
MOBILE CLINIC 25 (GO TO 327)
FIELD WORKER 26 (GO TO 327)
FP/PPAG CLINIC 27
MATERNITY HOME 28
OTHER PRIVATE (SPECIFY) ____ 29
SHOP 32
FRIEND/RELATIVE 33 (GO TO 327)
326B. How long does it usually take to travel from your home to this place?
DON'T KNOW 998
326C. Is it easy or difficult to get there?
DIFFICULT 2
DON'T KNOW 8
327. Do you know another place where you could have obtained (METHOD) the last time?
NO 2 (GO TO 401)
327A. At the time of the sterilization operation, did you know another place where you could have received the operation?
NO 2 (GO TO 401)
328. People select the place where they get family planning services for various reasons.
What was the main reason you went to (NAME OF PLACE IN Q. 326 or Q. 318) instead of the other place you know about?
RECORD RESPONSE AND CIRCLE CODE _____
CLOSER TO MARKET/WORK 12 (GO TO 401)
AVAILABILITY OF TRANSPORT 13 (GO TO 401)
CLEANER FACILITY 22 (GO TO 401)
OFFERS MORE PRIVACY 23 (GO TO 401)
SHORTER WAITING TIME 24 (GO TO 401)
LONGER HRS OF SERVICE 25 (GO TO 401)
USE OTHER SERVICES AT THE FACILITY 26 (GO TO 401)
WANTED ANONYMITY 41 (GO TO 401)
OTHER (SPECIFY) ____ 96 (GO TO 401)
DON'T KNOW 98 (GO TO 401)
329. What was the last method of family planning you or your husband/partner used?
IUD 02
INJECTIONS 03
NORPLANT 04
DIAPHRAGM/FOAM/JELLY 05
CONDOM 06
FEMALE STERILIZATION 07
MALE STERILIZATION 08
PERIODIC ABSTINENCE 09
WITHDRAWAL 10
LACTATIONAL AMENORRHEA METHOD 11
OTHER (SPECIFY) ____ 96
329A. For how many months did you use the method continuously?
329B. What is the main reason you are not using a method of contraception to avoid pregnancy?
INFREQUENT SEX 22
MENOPAUSAL/HYSTERECTOMY 23
SUBFECUND/INFECUND 24
POSTPARTUM/BREASTFEEDING 25
WANTS (MORE) CHILDREN 26
PREGNANT 27
HUSBAND/PARTNER OPPOSED 32
OTHER OPPOSED 33
RELIGIOUS PROHIBIITON 34
KNOWS NO SOURCE 42
FEAR OF SIDE EFFECTS 52
LACK OF ACCESS/TOO FAR 53
COST TOO MUCH 54
INCONVENIENT TO USE 55
INTERFERES WITH BODY'S NATURAL PROCESS 56
DON'T KNOW 98
330. Do you know of a place where you can obtain a method of family planning?
NO 2 (GO TO 401)
331. Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTRE, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
GVT. HEALTH CENTRE 12
FAMILY PLANNING CLINIC 13
MOBILE CLINIC 14
FIELD WORKER 15
OTHER PUBLIC (SPECIFY) ____ 16
PHARMACY 22
CHEMIST 23
DRUG STORE 24
MOBILE CLINIC 25
FIELD WORKER 26
FP/PPAG CLINIC 27
MATERNITY HOME 28
OTHER PRIVATE (SPECIFY) ____ 29
SHOP 32
FRIEND/RELATIVE 33
OTHER (SPECIFY) ______ 36
SECTION 4A. PREGNANCY AND BREASTFEEDING
NO PREGNANCIES SINCE JANUARY 1993 OR Q. 233 IS BLANK (GO TO 465)
402. ENTER THE PREGNANCY LINE NUMBER, NAME (IF LIVE BIRTH), AND SURVIVAL STATUS (IF LIVE BIRTH) OF EACH PREGNANCY SINCE JANUARY 1993 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE PREGNANCIES. BEGIN WITH THE LAST PREGNANCY.
(IF THERE ARE MORE THAN 3 PREGNANCIES, USE ADDITIONAL QUESTIONNAIRES).
Now I would like to ask you some questions about all your pregnancies in the last five years. We will talk about each separately.
404. FOR LIVE BIRTHS ONLY: NAME FROM Q.218 AND SURVIVAL STATUS FROM Q.221.
DEAD __ (GO TO 405)
405. At the time you became pregnant (with NAME), did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all?
LATER 2
NO MORE 3 (GO TO 407)
406. At the time you became pregnant (with NAME) how much longer would you like to have waited?
YEARS 2 __
DON'T KNOW 998
407. When you were pregnant (with NAME), did you see anyone for antenatal care for this pregnancy? IF YES: Whom did you see? Anyone else?
PROBE FOR THE TYPES OF PERSON AND RECORD ALL PERSONS SEEN.
NURSE B
MIDWIFE C
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
NO ONE Y (GO TO 410)
407A. Were you given an antenatal ID card for this pregnancy?
NO 2
DON'T KNOW 8
408. How many months pregnant were you when you first received antenatal care?
DON'T KNOW 98
408A. How many months pregnant were you at your last antenatal visit?
DON'T KNOW 98
408B. During this pregnancy, did you have any of the following performed at least once during any of your antenatal visits?
Weight measured?
Height measured?
Blood pressure measured?
Urine tested?
Blood tested?
NO 2
NO 2
NO 2
NO 2
NO 2
409. How many times did you receive antenatal care during this pregnancy?
DON'T KNOW 98
410. When you were pregnant (with NAME) were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?
NO 2 (GO TO 412A)
DON'T KNOW 8 (GO TO 412A)
411. During this pregnancy, how many times did you get this injection?
DON'T KNOW 8
412A. When you were pregnant (with NAME) did you receive any iron tablets?
SHOW IRON TABLETS.
NO 2
DON'T KNOW 8
412B. When you were pregnant (with NAME) did you receive folic/folate acid tablets?
SHOW FOLIC/FOLATE ACID TABLETS.
NO 2
DON'T KNOW 8
IF LIVE BIRTH CONTINUE WITH Q. 413, IF OTHER PREGNANCY, GO BACK TO Q. 405 IN NEXT COLUMN, OR IF NOW MORE PREGNANCIES, GO TO Q. 439.
NEXT-TO-LAST BIRTH
IF LIVE BIRTH CONTINUE WITH Q. 413, IF OTHER PREGNANCY, GO BACK TO Q. 405 IN NEXT COLUMN, OR IF NOW MORE PREGNANCIES, GO TO Q. 439.
SECOND-FROM-LAST BIRTH
IF LIVE BIRTH CONTINUE WITH Q. 413, IF OTHER PREGNANCY, GO BACK TO Q. 405 IN NEXT COLUMN; OR IF NO MORE PREGNANCIES, GO TO Q. 439.
413.Where did you go to give birth to (NAME)?
TBA'S HOME 12
OTHER HOME 13
GVT. HEALTH CENTRE 22
GVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY)______ 26
MATERNITY HOME 32
OTHER PRIVATE (SPECIFY)______ 36
414. Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS ASSISTING.
NURSE B
MIDWIFE C
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
NO ONE Y
415. How was (NAME) delivered: normal, caesarian, or other?
CAESARIAN 2
OTHER (SPECIFY) _____ 3
DON'T KNOW 8
416. When (NAME) was born, was he/she: very large, large, average, small, or very small?
LARGE 2
AVERAGE 3
SMALL 4
VERY SMALL 5
DON'T KNOW 8
417. Was (NAME) weighed at birth?
NO 2 (GO TO 417B)
417A. How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE.
KILOGRAM FROM RECALL 2 __.__
DON'T KNOW 998
417B. In the six weeks after (NAME) was born, did anyone check on your health or the health of your baby?
NO 2 (GO TO 417G)
417C. How many days or weeks after the delivery did the first visit take place?
RECORD '00' DAYS IF SAME DAY.
WEEKS 2 __
DON'T KNOW 98
417D. Who checked on your health or the health of your baby at that time? Anyone else?
PROBE FOR THE TYPE OF PERSONS AND RECORD ALL PERSONS ASSISTING.
NURSE B
MIDWIFE C
UNTRAINED TRADITIONAL BIRTH ATTENDANT E
417E. Where did this first check-up take place?
TBA'S HOME 12
OTHER HOME 13
GVT. HEALTH CENTRE 22
GVT. HEALTH POST 23
OTHER PUBLIC (SPECIFY) ____ 26
MATERNITY HOME 32
OTHER PRIVATE (SPECIFY) ____ 36
417F. During this visit, did the health worker give you advice about any of the following?
New-born care?
Breastfeeding?
Complementary feeding?
Vitamins?
Immunizations?
Delivery complications?
Family planning?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
417G. Did you receive Vitamin A capsules within six weeks following the delivery of (NAME)?
SHOW VITAMIN A CAPSULE.
NO 2
418. Has your period returned since the birth of (NAME)? (LAST BIRTH ONLY)
[Most recent birth within the last five years]
NO 2 (GO TO 421)
419. Did your period return between the birth of (NAME) and your next pregnancy?
[Repeat questions for all children born in the last 5 years, excluding the most recent birth]
NO 2 (GO TO 423)
420. For how many months after the birth of (NAME) did you not have a period?
DON'T KNOW 98
421. CHECK 234: RESPONDENT PREGNANT?
LAST BIRTH ONLY
PREGNANT OR UNSURE __ (GO TO 423)
422. Have you resumed sexual relations since the birth of (NAME)?
[Most recent birth within the last five years]
NO 2 (GO TO 424)
423. For how many months after the birth of (NAME) did you not have sexual relations?
DON'T KNOW 98
424. Did you ever breastfeed (NAME)?
NO 2
424A. Why did you not breastfeed (NAME)?
CHILD ILL/WEAK 02 (GO TO 430)
CHILD DIED 03 (GO TO 430)
NIPPLE/BREAST PROBLEM 04 (GO TO 430)
INSUFFICIENT MILK 05 (GO TO 430)
MOTHER WORKING 06 (GO TO 430)
CHILD REFUSED 07 (GO TO 430)
OTHER (SPECIFY) ____ 96 (GO TO 430)
425. How long after birth did you first put (NAME) to the breast?
IF LESS THAN 1 HOUR, RECORD '00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS.
HOURS 1 __
DAYS 2 __
426. CHECK 404: CHILD ALIVE?
[Most recent birth within the last five years]
DEAD __ (GO TO 428)
427. Are you still breastfeeding (NAME)?
[Most recent birth within the last five years]
NO 2
428. For how many months did you breastfeed (NAME)?
DON'T KNOW 98
429. Why did you stop breastfeeding (NAME)?
CHILD ILL/WEAK 02
CHILD DIED 03
NIPPLE/BREAST PROBLEM 04
NOT ENOUGH MILK 05
MOTHER WORKING 06
CHILD REFUSED 07
WEANING AGE 08
BECAME PREGNANT 09
STARTED USING CONTRACEPTION 10
OTHER (SPECIFY) ____ 96
DEAD __ (GO BACK TO 405 IN NEXT COL. OR, IF NO MORE BIRTHS, GO TO 439)
431. How many times did you breastfeed (NAME) last night between sunset and sunrise?
IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER. (LAST BIRTH)
[Most recent birth within the last five years]
432. How many times did you breastfeed (NAME) yesterday during the daylight hours?
IF ANSWER IS NOT NUMERIC PROBE FOR APPROXIMATE NUMBER. (LAST BIRTH)
[Most recent birth within the last five years]
433. Did (NAME) drink anything from a bottle with a nipple yesterday or last night?
NO 2
DON'T KNOW 8
434. At any time yesterday or last night, was (NAME) given any of the following?
Plain water?
Sugar water?
Juice?
Baby formula?
Tinned/powdered/fresh milk?
Any other liquid?
Any solid or mushy food made from maize, rice, yam, weanimix, mpotompoto, or other grain/tuber?
Eggs, fish or poultry?
Meat?
Any other solid or semi-solid foods?
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
NO 2
DK 8
435. CHECK 434:
FOOD OR LIQUID GIVEN YESTERDAY?
"NO/DK" TO ALL __ (GO TO 439)
436. (Apart from breastfeeding,) how many times did (NAME) eat yesterday, including both meals and snacks?
IF 7 OR MORE TIMES, RECORD '7'.
DON'T KNOW 8
438. GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 439.
SECTION 4B. IMMUNIZATION AND HEALTH
NO LIVING CHILDREN BORN SINCE JANUARY 1993 __ (GO TO 465)
439A. ENTER THE LINE NUMBER AND NAME OF EACH LIVING CHILD BORN SINCE JANUARY 1993 IN THE TABLE.
ASK THE QUESTIONS ABOUT ALL OF THESE CHILDREN. BEGIN WITH THE YOUNGEST CHILD.
(IF THERE ARE MORE THAN 3 LIVING CHILDREN, USE ADDITIONAL QUESTIONNAIRES).
442. Do you have a card where (NAME'S) vaccinations are written down?
IF YES: May I see it please?
YES, NOT SEEN 2 (GO TO 446)
NO CARD 3
443. Did you ever have a vaccination card for (NAME)?
NO 2
444. (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.
(2) WRITE '44' IN 'DAY' COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE IS RECORDED.
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
MONTH __
YEAR __
445. Has (NAME) received any vaccinations that are not recorded on this card?
RECORD 'YES' ONLY IF RESPONDENT MENTIONS BCG, POLIO, 0-3, DPT 1-3, MEASLES AND/OR YELLOW FEVER VACCINE(S).
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)
446. Did (name) ever receive any vaccinations to prevent him/her from getting diseases?
NO 2 (GO TO 448)
DON'T KNOW 8 (GO TO 448)
447. Please tell me if (NAME) received any of the following:
447A. A BCG vaccinations against tuberculosis, that is, an injection in the arm that caused a scar?
NO 2
DON'T KNOW 8
447B. Polio vaccine, that is, drops in the mouth?
NO 2 (GO TO 447E)
DON'T KNOW 8 (GO TO 447E)
447D. When was the first polio vaccine given, just after birth or later?
LATER 2
447E. DPT vaccination, that is, an injection usually given at the same time as polio drops?
NO 2 (GO TO 447G)
DON'T KNOW 8 (GO TO 447G)
447G. An injection to prevent measles?
NO 2
DON'T KNOW 8
447H. An injection to prevent yellow fever?
NO 2
DON'T KNOW 8
448. During the last 6 months has (NAME) received Vitamin A capsules?
SHOW VITAMIN A CAPSULE.
NO 2
DON'T KNOW 8
448A. At any time in the last 6 months did (NAME) receive any health related home visits?
NO 2
DON'T KNOW 8
449. Has (NAME) been ill with a fever at any time in the last 2 weeks?
NO 2 (GO TO 450)
DON'T KNOW 8 (GO TO 450)
449B. What was given or done to treat the fever? Anything else?
RECORD ALL MENTIONED
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
SPONGING H
OTHER (SPECIFY) ___ X
449C. Did you seek advice or treatment for the fever?
NO 2 (GO TO 450)
449D. Where did you seek advice or treatment? Anywhere else?
PROBE FOR ALL THAT IS MENTIONED. RECORD ALL MENTIONED.
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X
450. Has (NAME) been ill with a cough at any time in the last 2 weeks?
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)
451. When (NAME) was ill with a cough, did he/she breathe faster than usual with short, fast breaths?
NO 2
DON'T KNOW 8
451A. Was anything given to treat the cough?
NO 2 (GO TO 454)
DON'T KNOW 8 (GO TO 454)
451B. What was given to treat the cough?
ANTIBIOTIC (PILL OR SYRUP) B
ANTIMALARIAL (PILL OR SYRUP) C
COUGH SYRUP D
OTHER PILL OR SYRUP E
UNKNOWN PILL OR SYRUP F
HOME REMEDY/HERBAL MEDICINE G
OTHER (SPECIFY) ____ H
452. Did you seek advice or treatment for the cough or difficult breathing?
NO 2 (GO TO 454)
453. Where did you seek advice or treatment? Anywhere else?
PROBE FOR ALL THAT IS MENTIONED. RECORD ALL MENTIONED.
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X
454. Has (NAME) had diarrhea, that is, loose or watery stool in the last 2 weeks?
NO 2 (GO TO 464)
DON'T KONW 8 (GO TO 464)
455. Was there any blood in the stools?
NO 2
DON'T KNOW 8
456. On the worst day of the diarrhea, how many bowel movements did (NAME) have?
DON'T KNOW 98
457. Was he/she given the same amount to drink as before the diarrhea, or more, or less?
MORE 2
LESS 3
DON'T KNOW 8
458. Was he/she given the same amount of food to eat as before the diarrhea, or more, or less?
MORE 2
LESS 3
DON'T KNOW 8
460. Was anything given to treat the diarrhea?
NO 2 (GO TO 462)
DON'T KNOW 8 (GO TO 462)
461. What was given to treat the diarrhea?
Anything else?
RECORD ALL MENTIONED.
RECOMMENDED HOME FLUID B
PILL OR SYRUP C
INJECTION D
(I.V.) INTRAVENOUS E
SUGAR-SALT-WATER SOL. F
HOME REMEDIES/HERBAL MEDICINES G
OTHER (SPECIFY) _____ X
462. Did you seek advice or treatment for the diarrhea?
NO 2 (GO TO 464)
463. Where did you seek advice or treatment? Anywhere else?
PROBE FOR ALL THAT IS MENTIONED.
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X
464. LIVING CHILD
GO BACK TO 442 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 465.
465. When a child has diarrhea, should he/she be given the same amount to drink, more or less than usual?
MORE 2
LESS 3
DON'T KNOW 8
466. When a child has diarrhea, should he/she be given the same amount to eat, more or less than usual?
MORE 2
LESS 3
DON'T KNOW 8
467. When a child is sick with diarrhea, what signs of illness would tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.
ANY WATERY STOOLS B
REPEATED VOMITING C
ANY VOMITING D
BLOOD IN STOOLS E
FEVER F
MARKED THIRST G
NOT EATING/NOT DRINKING WELL H
GETTING SICKER/VERY SICK I
NOT GETTING BETTER J
OTHER (SPECIFY) _____ X
DON'T KNOW Z
468. When a child is sick with a cough, what signs of illness would you tell you that he or she should be taken to a health facility or health worker?
RECORD ALL MENTIONED.
DIFFICULT BREATHING B
NOISY BREATHING C
FEVER D
CHEST IN DRAWING E
UNABLE TO DRINK F
NOT EATING/NOT DRINKING WELL G
GETTING SICKER/VERY SICK H
NOT GETTING BETTER I
OTHER (SPECIFY) _____ X
DON'T KNOW Z
ANY CHILD RECEIVED ORS ___ (GO TO 470B)
470. Have you ever heard of a special product called ORS you can get for treatment of diarrhea?
NO 2
470A. Have you ever seen (a) packet(s) like this?
SHOW ORS PACKETS LIKELY TO BE USED IN THE LOCALITY OF THE INTERVIEW.
NO 2 (GO TO 501)
471A. Did you prepare the whole packet at once or only part of the packet?
ONLY PART OF PACKET 2 (GO TO 472)
471B. How much water did you mix with a packet of ORS?
1 LITER 02
1 1/2 LITER 03
1 BEER BOTTLE 04
FOLLOWED PACKAGE INSTRUCTIONS 05
OTHER (SPECIFY) _____ 96
DON'T KNOW 98
472. Where can you buy or obtain a packet of ORS? PROBE: Anywhere else?
RECORD ALL MENTIONED.
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM HEALTH WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY/DRUGSTORE/CHEMIST H
CLINIC I
MOBILE CLINIC J
COMM. HEALTH WORKER K
OTHER PRIVATE (SPECIFY) _____ L
TRAD. PRACTITIONER N
DRUG PEDDLER O
OTHER (SPECIFY) _____ X
501. PRESENCE OF OTHERS AT THIS POINT.
NO 2
NO 2
NO 2
NO 2
502. Are you currently married or living with a man?
YES, LIVING WITH A MAN 2 (GO TO 507)
NO, NOT IN UNION 3
503. Do you currently have a regular sexual partner, an occasional sexual partner, or no sexual partner at all?
OCCASIONAL SEXUAL PARTNER 2
NO SEXUAL PARTNER 3
504. Have you ever been married or lived with a man?
YES, LIVED WITH A MAN 2 (GO TO 511)
NO 3 (GO TO 515)
506. What is your marital status now: are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 511)
SEPARATED 3 (GO TO 511)
507. Is your husband/partner living with you now or is he staying elsewhere?
STAYING ELSEWHERE 2
507A. WRITE THE LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR HER HUSBAND/PARTNER. IF HUSBAND/PARTNER IS NOT LISTED WRITE '00'.
508. Does your husband/partner have any other wives besides yourself?
NO 2 (GO TO 511)
509. How many other wives does he have?
DON'T KNOW 98 (GO TO 511)
510. Are you the first, second, .... wife?
511. Have you been married or lived with a man only once, or more than once?
MORE THAN ONCE 2
MARRIED/LIVED WITH A MAN ONLY ONCE __ (In what month and year did you start living with your husband/partner?)
MARRIED/LIVED WITH A MAN MORE THAN ONCE __ (Now we will talk about your first husband/partner. In what month and year did you start living with him?)
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
513. How old were you when you started living with him?
MARRIED/LIVED WITH A MAN ONLY ONCE __ (GO TO 515)
MARRIED/LIVED WITH A MAN MORE THAN ONCE __ (Now we will talk about your current husband/partner. In what month and year did you start living with him?)
DON'T KNOW MONTH 98
YEAR 19___
DON'T KNOW YEAR 9998
515. Now I need to ask you some questions about sexual activity in order to gain a better understanding of some family planning issues.
When was the last time you had sexual intercourse (if ever)?
DAYS AGO 1 __
WEEKS AGO 2 __
MONTHS AGO 3 __
YEARS AGO 4 __
BEFORE LAST BIRTH 996
KNOWS CONDOM __ (The last time you had sex, was a condom used?)
DOES NOT KNOW CONDOM __ (Some men use a condom, which means that they put a rubber sheath on their penis during sexual intercourse. The last time you had sex, was a condom used?)
NO 2
DON'T KNOW 8
517. Do you know of a place where you can get condoms?
NO 2 (GO TO 519)
518. Where is that? Anywhere else?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. RECORD ALL MENTIONED.
GVT. HEALTH CENTRE B
FAMILY PLANNING CLINIC C
MOBILE CLINIC D
FIELD WORKER E
OTHER PUBLIC (SPECIFY) ____ F
PHARMACY H
CHEMIST I
DRUG STORE J
MOBLIE CLINIC K
FIELD WORKER L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE (SPECIFY) ____O
SHOP Q
FRIEND/RELATIVE R
OTHER (SPECIFY) _____ S
519. How old were you when you first had sexual intercourse?
FIRST TIME WHEN MARRIED 96
520. How old were you when you first had your menstrual period?
SECTION 6. FERTILITY PREFERENCES
HE OR SHE STERILIZED __ (GO TO 612)
NOT PREGNANT OR UNSURE __ (Now I have some questions about the future. Would you like to (a/another) child, or would you prefer not to have any (more) children?)
PREGNANT __ (Now I have some questions about the future. After the child you are expecting now, would you like to have another child, or would you prefer not to have any more children?)
NO MORE/NONE 2 (GO TO 604)
SAYS SHE CAN'T GET PREGNANT 3 (GO TO 606)
UNDECIDED/DON'T KNOW 8 (GO TO 604)
NOT PREGNANT OR UNSURE __ (How long would you like to wait form now before the birth of (a/another) child?)
PREGNANT __ (After the child you are expecting now, how long would you like to wait before the birth of another child?)
YEARS 2 __
SOON/NOW 996 (GO TO 606)
SAYS SHE CAN'T GET PREGNANT 994 (GO TO 606)
AFTER MARRIGE 995
OTHER (SPECIFY) ___ 996
DON'T KNOW 998
PREGNANT __ (GO TO 607)
605. If you became pregnant in the next few weeks, would you be happy, unhappy, or would it not matter very much?
UNHAPPY 2
WOULD NOT MATTER 3
606. CHECK 314: USING A METHOD?
NOT CURRENTLY USING __ (GO TO 607)
CURRENTLY USING __ (GO TO 612)
607. Do you think you will use a method to delay or avoid pregnancy within the next 12 months?
NO 2
DON'T KNOW 8
608. Do you think you will use a method to delay or avoid pregnancy at any time in the future?
NO 2 (GO TO 610)
DON'T KNOW 8 (GO TO 610)
609. Which method would you prefer to use?
IUD 02 (GO TO 612)
INJECTIONS 03 (GO TO 612)
IMPLANTS 04 (GO TO 612)
DIAPHRAGM/FOAM/JELLY 05 (GO TO 612)
CONDOM 06 (GO TO 612)
FEMALE STERILIZATION 07 (GO TO 612)
MALE STERILIZATION 08 (GO TO 612)
PERIODIC ABSTINENCE 09 (GO TO 612)
WITHDRAWAL 10 (GO TO 612)
LACATIONAL AMENORRHEA METHOD 11 (GO TO 612)
OTHER (SPECIFY) _____ 96 (GO TO 612)
UNSURE 98 (GO TO 612)
610. What is the main reason that you think you will never use a method?
MENOPAUSAL/WOMB REMOVED 23 (GO TO 612)
SUBFECUND/INFECUND 24 (GO TO 612)
WANTS MORE CHILDREN 26 (GO TO 612)
HUSBAND/PARTNER OPPOSED 32 (GO TO 612)
OTHERS OPPOSED 33 (GO TO 612)
RELIGIOUS PROHIBITION 34 (GO TO 612)
KNOWS NO SOURCE 42 (GO TO 612)
FEAR OF SIDE EFFECTS 52 (GO TO 612)
LACK OF ACCESS/TOO FAR 53 (GO TO 612)
COST TOO MUCH 54 (GO TO 612)
INCONVENIENT TO USE 55 (GO TO 612)
INTERFERES WITH BODY'S NORMAL PROCESSES 56 (GO TO 612)
DON'T KNOW 98 (GO TO 612)
611. Would you ever use a method if you were married?
NO 2
DON'T KNOW 8
HAS LIVING CHILDREN __ (If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?)
NO LIVING CHILDREN __ (If you could choose exactly the number of children to have in your whole life, how many would that be?)
PROBE FOR A NUMERIC RESPONSE.
OTHER (SPECIFY) ____ 96 (GO TO 614)
613. How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter?
UP TO GOD 95
OTHER (SPECIFY) ____ 96
UP TO GOD 95
OTHER (SPECIFY) ____ 96
UP TO GOD 95
OTHER (SPECIFY) ____ 96
614. Would you say that you approve or disapprove of couples using a method to avoid getting pregnant?
DISAPPROVE 2
NO OPINION 3
615. Is it acceptable or not acceptable to you for information on family planning to be provided:
On the radio? On the television?
NOT ACCEPTABLE 2
DK 8
NOT ACCEPTABLE 2
DK 8
616. In the last few months have you heard about family planning:
On the radio?
On the television?
In a newspaper or magazine?
From a poster?
From leaflets or brochures?
NO 2
NO 2
NO 2
NO 2
NO 2
618. In the last few months have you discussed the practice of family planning with your friends, neighbors, or relatives?
NO 2 (GO TO 620)
619. With whom? Anyone else?
RECORD ALL MENTIONED.
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
DAUGHTER F
MOTHER-IN-LAW G
FRIENDS/NEIGHBORS H
OTHER (SPECIFY) ____ X
YES, LIVING WITH A MAN __ (GO TO 621)
NO, NOT IN UNION __ (GO TO 701)
621. Spouses/partners do not always agree on everything. Now I want to ask you about your husband's/partner's views on family planning.
Do you think that your husband/partner approves or disapproves of couples using a method to avoid pregnancy?
DISAPPROVES 2
DON'T KNOW 8
622. How often have you talked to your husband/partner about family planning in the past year?
ONCE OR TWICE 2
MORE OFTEN 3
623. Do you think your husband/partner wants the same number of children that you want, or does he want more or fewer than you want?
MORE CHILDREN 2
FEWER CHILDREN 3
DON'T KNOW 8
SECTION 7. HUSBAND'S/PARTNER'S BACKGROUND AND WOMAN'S WORK
FORMERLY MARRIED/LIVED WITH A MAN __ (GO TO 703)
NEVER MARRIED AND NEVER IN UNION __ (GO TO 709)
702. How old was your husband/partner on his last birthday?
703. Did your (last) husband/partner ever attend school?
NO 2 (GO TO 706)
704. What was the highest level of school he attended: primary, middle/jss, secondary/sss, or higher?
MIDDLE/JSS 2
SECONDARY/SSS 3
HIGHER 4
DON'T KNOW 8 (GO TO 706)
705. What was the highest grade he completed at that level?
DON'T KNOW 98
706. What (is/was) your (last) husband/partner's occupation?
That is, what kind of work (does/did) he mainly do?
_____________
_____________
DOES (DID) NOT WORK IN AGRECULTURE __ (GO TO 709)
708. (Does/did) your husband/partner work mainly on his own land or on family land, or (does/did) he rent land, or (does/did) he work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
709. Aside from your own housework, are you currently working?
NO 2
710. As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business or work on the family farm or in the family business.
Are you currently doing any of these things or any other work?
NO 2
711. Have you done any work in the last 12 months?
NO 2 (GO TO 801)
712. What is your occupation, that is, what kind of work do you mainly do?
____________
____________
DOES NOT WORK IN AGRICULTURE __ (GO TO 715)
714. Do you work mainly on your own land or on family land, or do you rent land
or work on someone else's land?
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
715. Do you do this work for a member of your family, for someone else, or are you self-employed?
SOMEONE ELSE 2
SELF-EMPLOYED 3
716. Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3 (GO TO 719)
717. During the last 12 months, how many months did you work?
718. During the last 12 months, how many days a week did you usually work (in the months that you worked)?
719. During the last 12 months, approximately how many days did you work?
720. Do you earn cash for your work?
PROBE: Do you make money for working?
NO 2 (GO TO 723)
721. How much do you usually earn for this work?
PROBE: Is this by the day, by the week, or by the month?
PER DAY 2 _____
PER WEEK 3_____
PER MONTH 4_____
PER YEAR 5_____
OTHER (SPECIFY) ______ 9999996
YES, CURRENTLY MARRIED YES, LIVING WITH A MAN __ (Who mainly decides how the money you earn will be used: you, your husband/partner, you and your husband/partner jointly, or someone else?)
NO, NOT IN UNION __ (Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly?)
HUSBAND/PARTNER DECIDES 2
JOINTLY WITH HUSBAND/PARTNER 3
SOMEONE ELSE DECIDES 4
JOINTLY WITH SOMEONE ELSE 5
723. Do you usually work at home or away from home?
AWAY 2
724 .CHECK 222 AND 223:
IS A CHILD LIVING AT HOME WHO IS AGE 5 OR LESS?
NO __ (GO TO 801)
725. Who usually takes care of (NAME OF YOUNGEST CHILD AT HOME) while you are working?
HUSBAND/PARTNER 02
OLDER FEMALE CHILD 03
OLDER MALE CHILD 04
OTHER RELATIVES 05
NEIGHBORS 06
FRIENDS 07
SERVANTS/HIRED HELP 08
CHILD IS IN SCHOOL 09
INSTITUTIONAL CHILD CARE 10
HAS NOT WORKED SINCE LAST BIRTH 95
OTHER (SPECIFY) ____ 96
801. Now I have a few questions about a very important topic. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 814)
802. From which sources of information have you learned most about AIDS? Any other sources?
RECORD ALL MENTIONED.
TELEVISION B
NEWSPAPERS/MAGAZINES C
PAMPHLETS/POSTERS D
SLOGANS/MUSIC E
HEALTH WORKERS F
CHURCHES/MOSQUES G
SCHOOLS/TEACHERS H
COMMUNITY MEETINGS I
FRIENDS/RELATIVES J
WORK PLACE K
OTHER (SPECIFY) ____ X
803. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS?
NO 2 (GO TO 807)
DON'T KNOW 3 (GO TO 807)
804. What can a person do? Any other ways?
RECORD ALL MENTIONED.
ABSTAIN FROM SEX B
USE CONDOM C
HAVE ONLY ONE SEX PARTNER D
AVOID SEX WTIH PROSTITUTES E
AVOID SEX WITH HOMOSEXUALS F
AVOID BLOOD TRANSFUSIONS G
AVOID INJECTIONS H
AVOID INFECTED NEEDLES I
AVOID KISSING J
AVOID MOSQUITO BITES K
AVOID SHARING INFECTED BLADES L
SEEK PROTECTION FROM TRADITIONAL HEALER M
OTHER (SPECIFY) ____ W
OTHER (SPECIFY) ____ X
DON'T KNOW Z
DID NOT MENTION SAFE SEX __ (GO TO 807)
806. What does "safe sex" mean to you?
USE CONDOMS B
HAVE ONLY ONE SEX PARTNER C
AVOID SEX WITH PROSTITUTES D
AVOID SEX WITH HOMOSEXUALS E
OTHER (SPECIFY) ____ X
DON'T KNOW Z
807. Is it possible for a healthy looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
808. Is it possible for a woman who has the AIDS virus to give birth to a child with the AIDS virus?
NO 2
DON'T KNOW 8
809. Is it possible for a woman who has the AIDS virus to pass the virus to her child through breastfeeding?
NO 2
DON'T KNOW 8
810. What do you suggest is the most important thing the government should do for people who have AIDS?
HELP RELATIVES PROVIDE CARE 2
ISOLATE/QUARANTINE 3
SHOULD NOT BE INVOLVED 4
OTHER (SPECIFY) ___ 6
811. If your relative is suffering from AIDS, who would you prefer to care for him/her?
FRIENDS 2
GOVERNMENT ORGANIZATION 3
RELIGIOUS ORGANIZATION 4
NOBODY/ABANDON 5
OTHER (SPECIFY) ____ 6
812. Do you think your chances of getting AIDS are small, moderate, great, or that you have no risk at all?
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS AIDS 5
DON'T KNOW 8
813. Has your knowledge of AIDS influenced or changed your decisions about having sex or your sexual behavior? IF YES, PROBE: In what way?
RECORD ALL MENTIONED.
STOPPED ALL SEX B
STARTED USING CONDOMS C
RESTRICTED SEX TO ONE PARTNER D
REDUCED NUMBER OF PARTNERS E
STOPPED SEX WITH PROSTITUTES F
STOPPED HOMOSEXUAL CONTACTS G
OTHER (SPECIFY) _____ X
NO CHANGE IN SEXUAL BEHAVIOR Y
DON'T KNOW Z
814. Have you heard of other diseases apart from AIDS which could be transmitted through sexual intercourse?
NO 2 (GO TO 818)
815. Name the diseases. Any other?
CIRCLE ALL MENTIONED.
SYPHILIS B
HERPES C
HEPATITIS D
OTHER (SPECIFY) ____ E
816. FOR EACH DISEASE MENTIONED IN Q.815 ASK THE FOLLOWING QUESTION AND CIRCLE ALL THE PLACES MENTIONED:
Where can a person go to treat (NAME OF DISEASE)? Anywhere else?
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
GVT. HEALTH CENTRE B
GVT. HEALTH POST C
MOBILE CLINIC D
COMM. HEALTH WORKER E
PHARMACY/CHEMIST/DRUG STORE G
CLINIC H
MOBILE CLINIC J
COMM. HEALTH WORKER
DRUG PEDDLER L
TRADITIONAL PRACTITIONER N
FAITH HEALER/SPIRITUALIST N
817. Do you think your chances of getting sexually transmitted diseases (STDs), other than AIDS, are small, moderate, great, or that you have no risk at all?
MODERATE 2
GREAT 3
NO RISK AT ALL 4
HAS STDs 5
DON'T KNOW 8
MINUTES ___
NO CHILDREN SINCE JANUARY 1993 __ (END)
IN 902 (COLUMNS 2 AND 3) RECORD THE LINE NUMBER FOR EACH CHILD BORN SINCE JANUARY 1993 AND STILL ALIVE.
IN 903 AND 904 RECORD THE NAME (ALL COLUMNS) AND BIRTH DATE (COLUMNS 2, 3 AND 4) FOR THE RESPONDENT AND FOR ALL LIVING CHILDREN BORN SINCE JANUARY 1993.
IN 906 AND 908 RECORD HEIGHT AND WEIGHT OF THE RESPONDENT AND THE LIVING CHILDREN.
(NOTE: ALL RESPONDENTS WITH ONE OR MORE BIRTHS SINCE JANUARY 1993 SHOULD BE WEIGHED AND MEASURED EVEN IF ALL OF THE CHILDREN HAVE DIED. IF THERE ARE MORE THAN 3 LIVING CHILDREN SINCE JANUARY 1993, USE ADDITIONAL QUESTIONNAIRES).
903. NAME FROM Q218 FOR CHILDREN
904. DATE OF BIRTH FROM Q105 FOR RESPONDENT AND FROM Q220 FOR CHILDREN, AND ASK FOR DAY OF BIRTH
YEAR 19__
YEAR 19__
905. BCG SCAR ON TOP OF SHOULDER
NO SCAR 2
907. WAS LENGTH/HEIGHT OF CHILD MEASURED LYING DOWN OR STANDING UP?
STANDING 2
909. LEFT UPPER ARM CIRCUMFERENCE (In centimeters)
910. DATE WEIGHED AND MEASURED
MONTH ___
YEAR 19__
MONTH ___
YEAR 19__
911. RESULT OF WEIGHING AND MEASURING
NOT PRESENT 3
REFUSED 4
OTHER (SPECIFY) ____ 6
CHILD SICK 2
NOT PRESENT 3
CHILD REFUSED 4
MOTHER REFUSED 5
OTHER (SPECIFY) ____ 6
NAME OF ASSISTANT: ______ ___
INTERVIEWER'S OBSERVATIONS
To be filled in after completing interview
Comments about Respondent:
______________________
______________________
______________________
Comments on Specific Questions:
______________________
______________________
______________________
Any Other Comments:
______________________
______________________
______________________
SUPERVISOR'S OBSERVATIONS
______________________
______________________
______________________
Name of Supervisor Date:
EDITOR'S OBSERVATIONS
Name of Editor: __________
Date: _____